中链甘油三酯对手术后接受肠外营养患者代谢的影响

Metabolic effects of medium-chain triglycerides in parenteral nutrition after surgery

目的 比较长链甘油三酯 (LCT)和中链甘油三酯 (MCT) 2种脂肪乳的代谢效应差异。方法 2 4例胃、结肠手术患者和 6例志愿者参加本研究 ,均有知情同意。患者随机分为 2组 ,分别接受含 5 0 %MCT或单纯LCT的肠外营养。测定前臂动静脉血中甘油三酯的浓度差及氮平衡。 结果MCT组肌肉利用脂肪乳的能力明显提高 ,氮平衡也有所改善 ,且术后体重减轻较少。在脂肪乳廓清试验中发现 ,血清酮体浓度MCT组 [(0 .0 6 3± 0 .0 0 4)mmol/L]明显高于LCT组 [(0 .0 39± 0 .0 0 2 )mmol/L]。氮储存的增加与酮体和胰岛素水平的增加相关。 结论 含 5 0 %MCT的脂肪乳用于肠外营养是安全的 。

Objective To investigate the difference between long chain triglycerides (LCT)and medium chain triglyceride (MCT). Methods Twenty four surgical patients and 6 volunteers were studied. These subjects were randomly assigned to receive parenteral nutrition with MCT or LCT emulsion. Their arterial and venous concentrations were measured across the forearm. Results Muscle utilization was significantly improved with MCT administration. In fat clearance test, serum ketone concentrations were significantly higher in the MCT group than in the LCT group. The improvement in nitrogen retention may be associated with the increasing of ketone and insulin levels. Conclusions Fat emulsions containing 50%MCT are safe for use in parenteral nutrition and provide an alternate fuel that improves protein metabolism.